Is swine flu more dangerous than other types of influenza or seasonal flu?

I knew I had to write this post when my domestic worker came to me in a panic. She was wearing a hankerchief over her mouth and was convinced that if she gets swine flu she will die. When I told her that most healthy people do not need medicine to be cured of the flu she didn’t believe me. On television they are saying something else she said. Well, this may not be exactly right but what is true is that every single channel, in every language, has nothing to talk about but swine flu and how dangerous and contagious it is. It does seem as if the plague has hit us! These screaming headlines are doing nothing to keep people calm.

Yes, there are doctors who are taking questions and informing the public not to panic, that it’s curable even without medication, that swine flu is a mild disease, that only vulnerable people get complications and die, but we are being bombarded with so much information and it is so continuous that people have become confused. And the images on television are disturbing. Disturbing enough to worry the most enlightened people. Images of panicky people, long lines for testing, news of increasing deaths, and also contradictory statements by doctors. One says that the earlier you take Tamiflu the better it is or it might lead to serious complications, another who says that wait and watch and see if it gets cured on its own. One says Tamiflu has to be given in the first 48 hours or it is of no use, and another says that one should only give it only if the patient is seriously ill, because of the serious side-effects. I am sure all of these statements must have some truth in them but most non-medical people don’t know what to make of it. One doctor actually said that we don’t know enough about the flu so one cannot be sure how exactly to deal with it! Well, I am sure humans don’t know enough about most diseases, but such statements confuse people.

And there is no doubt that some channels are being alarmist. I mean, for heavans sake this evening Times Now was talking in terms of “survivors”!!

Lets see what swine flu actually is. How fatal it is.

Is swine flu more dangerous than other kinds of flu?
The most important thing we need to know is whether swine flu kills more people than other kinds of flu. I don’t want to talk in terms of symptoms because symptoms vary. It’s the death rate that we should check. In India we are so used to flu that we treat it very casually, secure in the knowledge that we are not going to die. So is there something more virulent and fatal about swine flu? We can compare statistics of western countries because in India there are no flu statistics available.

The mortality rate for swine flu is believed to range from 0.1% to about 0.5%, meaning that about one to five people die for every 1000 people infected. Some consider this to be an overestimation because of “the unknown number of infected people, who recover at home without notifying their doctors that they are ill, or receiving a diagnosis”. In poorer countries with not so efficient health systems (say Mexico, where a large number of deaths were reported) the proportion of such people will be higher, leading to a wrong estimation of the death rate for swine flu. I am sure that in India too hundreds of people have had mild swine flu symptoms and have recovered without knowing they had it.

The mortality rate from normal influenza is more than 0.5% and can rise to even 25% or more in certain countries!! If you have any doubts check the following links which give this information. [1], [2], [3]. There are many many types of flu, some worse than others, but it doesn’t seem as if swine flu is the worst one.

However, swine flu does seem to be more contagious and while some sites say the symptoms are more severe, no one says that the death rate is more than that of other types of flu. Yes, vulnerable people like pregnant women, the elderly, young children and others with health problems should be careful not to go out to crowded places during this time. Or during any flu season. Hand hygeine is a must at all times, for all. It’s not just flu that we in India can catch. It’s also Typhoid and Cholera.

Calculating flu deaths
Ever wondered why India doesn’t usually report flu deaths although we have flu here all round the year? In developed countries a large number of people die from different strains of flu and they take flu vaccines too. Hardly anyone in India does that. We just live with the flu. In India, when one’s flu progresses from a simple influenza to pneumonia and the patient dies, it is commonly referred to as death from pneumonia, not flu. In western countries this is not the case. For some strange reason, probably due to pressure from the WHO, India is has now changed its strategy and is now reporting deaths arising from complications of swine flu, as swine flu deaths. I am not saying its wrong, in fact its right, but it can give the wrong impression to people. They have never heard of flu deaths, but now they are hearing of swine flu deaths. Naturally, they think this flu is deadly. But is there any evidence so far to tell us that swine flu is more dangerous than some other types of influenza?

Dubbing a death from pneumonia, brought on by a flu virus, as a flu death, is something we in India are not familiar with. So used as we are to diseases like Typhoid and Malaria and TB that any disease being a contributory cause has not ingrained itself on our psyche. In fact there are those in the west who believe that even deaths of heart patients who have died from from heart attacks and strokes (to which flu has contributed) should also be categorised as flu deaths. In some cases, and in some countries, they are, although one does not know exactly how it is all calculated.

It is important I think to make a distinction between a flu death and a flu associated death and this has been explained nicely here. It is an opinion that not all doctors would agree with, or feel comfortable with, but it made sense to me. A Harvard University graduate, Peter Doshi, wrote in the British Medical Journal:

US data on influenza death may be more PR than science, argues a Harvard University graduate student in this week’s British Medical Journal. The Centers for Disease Control and Prevention (CDC) acknowledges a difference between flu death and flu-associated death yet uses the terms interchangeably. Compounding these problems is a marketing of fear – a CDC communications strategy in which medical experts “predict dire outcomes” during flu seasons, he adds.

Whatever is the truth, the public should know clearly which is an actual flu death and in which cases the flu has simply aggravated an underlying condition. If it is the latter, then people have the right to know that swine flu is not the major cause and/or that it is not more dangerous than other types of flu. If this is kept wrapped in mystery and statistics then you will have people rushing to buy Tamiflu, even though the drug is known to have some serious side-effects. All in all, pharamaceutical companies are not complaining.

author of over 250 publications and research papers, including 10 books and several international awards) has this to say about swine flu’s death rate:

Death rate after H1N1 flu is low.We are oblivious of the facts. Deaths due to Swine flu are being blown out of proportion by media trying to create hysteria among lay people. Mortality of Swine flu is less than 0.1 % of those affected, that means may be one in 1,000 affected is likely to suffer the life loss. If one considers that real number of affected persons is several times of the reported cases, true mortality due to flu is much lower than 0.1 %. Affected children from the private schools and economically better of patients are reported, what about the children from Municipal Schools and slum dwellers?
Almost all cases of flu get naturally cured in couple of days as the infection is self-limiting. However, flu like illness should not be neglected…
We need to take care of children and elderly who are at high risk as they have less immunity and do not let them exposed to infection, e.g., by not going to crowded places or visit hospital…
This is also true of others at high risk, e.g., persons over 45 years of age, those who are diabetic, have high blood pressure or cardio-vascular disease, have asthma or other diseases of the lung…
Tamiflu is the antiviral drug that is being used, especially for H1N1 cases showing signs of seriousness. Efficacy of this drug has not been tested by clinical trials. As is the case with most of the antiviral drugs, none of them is curative and may be useful if administered during the early stage of infection. The cost of treatment with Tamiflu is Rs. 5,000=00. It is doubtful if Tamiflu is of any real benefit to the patients. In children Tamiflu may cause adverse side-effects..

I have the full text of Dr. Deodhar’s comments on swine flu if anyone is interested, I can send it my email. However I have extracted the important points here.

Another important update (17th Aug 2009) :

Steps to take to prevent H1N1 or Swine Flu or any other flu from making you ill/ Prevention of swine flu and seasonal flu:
This is not an official government advice, especially the part about face masks or N95, but it is advise from a doctor.

Most N95 respirators are designed to filter 95% particulates of 0.3µ, while the size of H1N1 virus is about 0.1µ. Hence, dependence on N95 to protect against H1N1 is like protecting against rain with an
umbrella made of mosquito net.

Tamiflu does not kill but prevents H1N1 from further proliferation till the virus limits itself in about 1-2 weeks (its natural cycle). H1N1, like other Influenza A viruses, only infects the upper respiratory tract and proliferates (only) there. The only portals of entry are the nostrils and mouth/ throat. In a global epidemic of this nature, it’s almost impossible not coming into contact with H1N1 in spite of all precautions. Contact with H1N1 is not so much of a problem as proliferation is.

While you are still healthy and not showing any symptoms of H1N1 infection, in order to prevent proliferation, aggravation of symptoms and development of secondary infections, some very simple steps – not fully highlighted in most official communications – can be

practiced (instead of focusing on how to stock N95 or Tamiflu):

1. Frequent hand-washing (well highlighted in all official communications).

2. “Hands-off-the-face” approach. Resist all temptations to touch any part of face (unless you want to eat, bathe or slap).

3. Gargle twice a day with warm salt water (use Listerine if you don’t trust salt). H1N1 takes 2-3 days after initial infection in the throat/ nasal cavity to proliferate and show characteristic symptoms. Simple gargling prevents proliferation. In a way, gargling with salt water has the same effect on a healthy individual that Tamiflu has on an infected one. Don’t underestimate this simple, inexpensive and powerful preventative method.

4. Similar to 3 above, clean your nostrils at least once every day with warm salt water. Not everybody may be good at Jala Neti or Sutra Neti (very good Yoga asanas to clean nasal cavities), but blowing the nose hard once a day and swabbing both nostrils with cotton buds dipped in warm salt water is very effective in bringing down viral population.

5. Boost your natural immunity with foods that are rich in Vitamin C (Amla and other citrus fruits). If you have to supplement with Vitamin C tablets, make sure that it also has Zinc to boost absorption.

6. Drink as much of warm liquids as you can. Drinking warm liquids has the same effect as gargling, but in the reverse direction. They wash off proliferating viruses from the throat into the stomach where they cannot survive, proliferate or do any harm.

All these are simple ways to prevent, within means of most households, and certainly much less painful than to wait in long queues outside public hospitals.

Happy breathing!

(First photograph from the Hindu and the second one is taken by me at Chennai airport and the third at Mumbai airport)

“The Indian Council of Medical Research plans to this year launch the country’s first ever study to assess death rates from seasonal flu. A senior scientist at the ICMR told The Telegraph that influenza was not viewed as a public health problem in India. “We have had to worry about dengue, malaria, Japanese encephalitis, diarrhoeal diseases — they all claim far many more lives every year.”

Yayaver, thanks for that link. It sort of bolsters up my post, when it says that there is no data on flu deaths (not swine flu) in India so there is no way we can compare the severity of the flu. At first I wondered whether people would take this post seriously as I am not a doctor or any kind of health service provider. I tried to do my research and presented what I found here. Also my instinct told me that swine flu being a dreaded disease is pure nonsense. Even in today’s paper I find these words like “dreaded” being used and a 16 year old boy recounts how he survived because his swine flu was detected quickly. At the same time he admits that he wasn’t even very sick, it’s just that he had a little fever and cold and his parents took him for testing. He says he is lucky to be alive!!😀

yahoo, swine flu is being treated because of the disease was sensationalised by the media after the death of Rida Shaikh. That is why people are demanding to be treated and demanding tamiflu. tamiflu should not be given as a preventive but I personally know two people who got it as a preventive from a govt. hospital in Pune even though they had no symptoms of swine flu!! All for free ofcourse, because this is at govt. cost. Even the tests are very expensive and needless tests have been conducted, all at govt cost.
and yes people are afraid of the long lines. The poor on the other hand are used to long lines. they suffer this for everything. we are used to pvt docs who treat us without us having to wait in such long lines. but pvt docs are not yet allowed to give out tami flu or test for swine flu.

Hmm..true. we are used to carrying the bug around , we don’t take leave if we have the flu. I think the media has as usual gone overboard causing panic among people…None of the channels have really explained what is swine flu exactly and they get these experts etc but never point out to simple facts like the probability of swine flu being fatal are low.

//The morbidity rate for swine flu is believed to range from 0.1% to about 0.5%, meaning that about one to five people die for every 1000 people infected.//

If you are really talking about the proportion of people dying, then the word you want is mortality not morbidity. You are only adding to the confusion🙂 and you are not even in the electronic visual media, to whom that privilege belongs🙂

I also feel that the disproportionate TV coverage given to the relatives of the first victim (in Pune) and their bravado-laden US-based NRI-style threats about suing Jahangir and/or Ruby set the tone for electronic media coverage in general. No one, not even the learned pundits — newscasters and panellists — that strut about on our so-called “national” news channels, seemed to pause to reflect that the correct diagnosis and treatment of a hitherto uknown virus cannot take off precisely from the word go.

Maybe these channels should be banned from covering anything more than the extra-curricular activities of bollywood stars, cricket stars, ramp stars and other socially disposable entities that make them so starry-eyed as to disconnect from all reality.
Vivek, thanks for pointing out that mistake. I have corrected the word. I have been reading so much about swine flu that I used that word by mistake. – Nita

my doctor tells me: the total deaths out of swine flu so far is 90 and the total deaths out of aids is more than a million and yet people are panicky about swine flu and buy all sorts of masks etc but not one bothers to use ‘masks’ to prevent aids.

maybe true/maybe not but there this is a statement indeed.

swine flu would not kill as many indians as the media would kill and the ruling govt is doing nothing to quell the hype. on top of that we have that foolish illiterate health minister coming out with statements such as 1 crore would be affected by december (now people can misread ‘affected’ as ‘dead’)

this same idiotic congress govt, which was so quick to create media blackout for striking govt officers and using the media to publish their own lying statements is noe giving the media a free hand to make the public go panicky. isn’t the indian govt hand in gloves with the pharmaceutical companies and the mask makers? don’t those rascals see profit in panic?

Jagmeet..although i suspected some foul play by the american pharma cos, after they killed all our kerala coconut palms by spraying a new virus, i did not expect man to stoop to such low levels as to actually profit from ‘created’ human misery! And all that for luxuriating materialistically during a mere 50 yrs of putrifying human existence on earth!

… greed of power and greed of money, or were the bio-technologists and medical community were just trying to have some fun?
(i.e. if those charges are true; whether proved guilty or not is a different matter)

Off-topic, but in the same league as your comment about the killing of the Kerala coconut palms, is the following extract from a Google chat I recently had with a correspondent living in Germany:

“…in the cotton industry, they use so much pesticide at the end that all the leaves fall off and then the cotton is picked by machines – this is normal in technology-rich cotton farming industries in USA and Russia. These unfortunately sell their cotton at such cheap prices that farmers in Mali, Burkina Faso and other African parts and Indian or Egyptian counterparts cannot keep up the pace plus USA farmers are heavily subsidised as well as EU farmers.”

Farm subsidies have a serious negative role on the American people too. Cheap and abundant food is making Americans Obese at an epidemic rate. Portion sizes are getting larger by the day in a desperation to sell. Meanwhile Pharma companies here have been lobbying for quite some time to reduce the standards of what defines Overweight and Obese and ‘make’ more people Obese. More than 10 different psychiatric drugs(with wight-loss as side-effect) are being tested and/or approved as weight-loss drugs.

vivek
our kerala coconut palms which once yielded in abundance every month now yields in ones and twos so much so that we have stopped plucking and wait for those ones and twos to fall of the tree. it is cheaper that way. what i learnt was some cos sprayed a certain wind-borne virus at kasargode and these got carried to the other parts of the state, thus killing the good, yielding, coconut trees. the once rich and healthy fruits now look mal-nutritioned and shrunk and all that despite putting abundant natural manure.
in line with what you said i remember having read some years ago how in certain countries the fertilizers used for rice cultivation killed the earth to such an extent that after 5 yrs of excellent yield these paddy fields became totally barren and nothing could grow there, not even wild shrubs.

Nothing much to add except asking people to maintain hygiene, avoid crowded places (Buses, malls, public places of worship, festivities..)

I personally avoid masks, because these filmy surgical masks do nothing to prevent the H1N1 virus to enter my nose or mouth.. Its better if if I wash my face and hands, before and after every time I travel..

I guess media should be cautious on what they are reporting in this case. The people are panicking and running to the govt hospitals to get themselves checked for Swine Flu…. The 24 hour count on the number of deaths is also adding fuel to the fire.

Nita,accepted the points raised and explained are quite relevant.I am not sure of the statstics.But I have a feeling,our electronic media is doing a bit of disservice to the cause.It is well known that anyone with flu symptoms must be quarantined immly and it takes 7-10 days to recover.We seem to be creating a scare beyond necessary.I do not expect any miracles from the Govt as they are not competent to handle any situation like this ,except when it comes to their own safety.All I can say is that one should try and remain clean,wash hands as often one can,use hanky while sneezing,avoid hand shake,avoid going to crowded places.But do not create panic by closing all schools,Malls etc.It spells panic.
I was in Singapore the other day when they were going through swine flu terror.But,it was commendable the way they handled the entire situation.It will be long to narrate the system but we have a long way before we can actually handle such situation.Please let us not spread panic.

BKC, let me assure you that the statistics are quite accurate. That is why I have taken them from different sources. The flu death toll is being calculated in western countries for years now, so it is not as if these stats are a one-off thing. In other words, the fact is that swine flu is not more dangerous than the seasonal flus when it comes to mortality rate. In fact there are indications that swine flu may be less dangerous. – Nita

BKC, hmm, I think you meant the lack of India stats. unfortunately in India a lot of people die of flu, but if you read the link that yayaver sent, you will see that soon in India they are going to start counting the death toll from seasonal flu. Once they do that, then people will take all flu seriously, like they are taking swine flu. For eg like in the US the well to do take flu shots. Specially some NRI’s I know who are visiting India!🙂
Actually all flu can be serious for vulnerable people. I am sure that in a few years from now there will be better data on swine flu (like there is on other seasonal flus) and from the trends that we are seeing, I feel that it will be found that swine flu has a lower death rate.

As always media hyped this one very well… as Raaz-Al-gul says in Batman begins… the media pressed the word panic…
I am yet to hear a news from media that the chances of flu attacking a healthier person is very less… LOL @ the TIMES NOW terming Survivors… yesterday night, I have watched in that channel, a group of people where discussing on this and none were optimistic…
great post Nita…🙂 good that you have brought out the real facts🙂

Nita, that was very nice of you to research on this and put together all the information. I was talking with folks in India and they tell me that it’s spreading in other areas in India as well. People are getting concerned there.
Although, as you also mentioned, media is making too much out of it and not giving the proper information most of the time.
Every year people die from various other flus as well, and experts seem to suggest that Swine flu is not very different from those various flus we have every year.

There is too much of panic and sensationalism created by the media. The toll of 23 so far in India is perhaps less the number of murders, accidents, suicides and other forms of unnatural deaths taking place in any big city in India on any given single day. “Much ado (panic) about nothing”, Shakespeare would say

What I do know is that the 1918 Spanish influenza killed over a million Indians and if I am not wrong killed half of the Indian army. When the second wave of the pandemic hits then we will know for sure if this flu is deadly or not, not before that. This is just the first wave.

The last two major flu epidemics seem to have skipped India mostly unscathed but I have the feeling that this one will do some damage. Well its just nature’s way of balancing the population. The more densely populated the place the more the chances the mortality rates from such diseases will be higher. For now simply washing hands will do I guess, the government has already washed their hands off it🙂

A piggery in Dunedoo, central NSW, Australia was quarantined after pigs caught swine flu from humans.

For details, see http[colon][slash][slash]news[dot]xinhuanet[dot]com[slash]english[slash]2009-08/03/content_11819441[dot]htm

I have provided this particular link because it is the most concise of the several agency reports available on the internet. Those determined to disbelieve it because it is from a commie source, please take your pick by googling the search string [Dunedoo>piggery>swine flu].

Vivek, that sure is funny!🙂 And by the way thanks for sending me the information about Dr. Deodhar. It was very useful indeed and authenticates my post. One additional thing he said which I want to add here. That almost everyone is going to get it!🙂 Now this should scare some people!🙂 – Nita

Hey, somehow, you always manage to show us the other side of things. In fact you relieved me. Such hype has been created by the media that people are literally panic stricken! But you have quite a few valid points there.

We are over-reacting to it / we have been under-reacting to other flu types – either one!

But, reading a few of the comments, it seems, the danger is not over as yet! We should rather cross our fingers and wait and see (and of course wash our hands with soap for 20 seconds from time to time)…

Good effort Nita, The epidemic caused by this new virus now termed by the CDC as the Novel H1N1 influenza A virus started in March of this year only. The knowledge of the medical community is limited abt features of this infection . The assumption that the morbidity and mortality is similar to the usual Human influenza A may not be correct as by the reports from Mexico and USA . Those dying are more in the adult age group and more healthier . I have collected some information in my blog malayalidoc.blogspot.com

Thus goes the saying “Unknown devil is more dangerous than the known devil”. Mainly because swine flu does not have any vaccine and any proper cure as of today, has led to more panic being created. The rich people getting affected more by swine flu was another reason due to which media got more and more involved. The intemperate statement of the Health Minister that one third of the population in India is likely to get infected by swine flu has added a further dimension to the problem. However, it appears that now for last 2-3 days, its spread has not accelerated at least.

Ashok, I am afraid it is not just rich people getting affected by this swine flu. Hordes of poor people are getting affected too. But they are not rushing for tests. For example my domestic worker told me that many people in her slum were down with fever, cough and cold. when I asked her whether they were testing themselves for swine flu, she laughed! Who has the time, she said! Even when something serious happens they avoid going to the doctor due to the long lines at government hospitals. In this particular thing the poor are behaving with some sense. They don’t see the coughs and colds and fever as anything “serious” and while I am not saying they are right as it can become serious, they are certainly seeing the illness in perspective more so because they have no other choice.

See Virulence column in Wikipedia for H1N1, It says:
Virulence
The CDC has noted that most infections continue to be mild—similar to seasonal flu—and recovery is extremely quick.[156] Some experts point out that the deaths so far are “a tiny fraction” of people who die every year from seasonal flu – with barely a public murmur.” One doctor said that “when there’s something that’s new and unknown, it scares people.”[157] Some medical journalists suggest that the news media may be overreacting to the new virus and have not compared its virulence with that of the regular “seasonal” flu.[158]

A recent internal CDC briefing noted, “20,000 people die from novel 2009-H1N1 and everybody wants to wear a mask. 9 million people die from AIDS and no one wants to wear a condom.

Thanks Jagmeet. That was a good link. I think the problem with the news media is that they lap up whatever news they get and regurgitate it. Whether it’s a simple press release or some other news. WHO is making a fuss about swine flu (as Shefaly pointed out) for whatever reasons, and the Indian media has replicated it here and made it into a frenzy, without thinking. Stupid and irresponsible it is. All that the news media had to do was to compare it to seasonal flu and see it in perspective. Not very difficult. But they were busy trying to show that whole of India was in some sort of terrible danger.

On another forum that I am part of, the role of Indian media in hyping swine flu hysteria is being discussed.

I would think a great deal of contribution comes from general health illiteracy in the masses, as well as general illiteracy even in the so-called educated classes. For instance, the latter should know better than to run for masks because H1N1 is not airborne and the wearing of the mask can actually create a breeding ground for other respiratory infections; also the diameters of pores in an ordinary mask are much larger in size than the average diameter of the H1N1 virus (about 0.12 microns) which means it can easily go through the pores making it a fruitless exercise which may even lead to false assurance about one’s risk exposure; also the real risk is from sneeze droplets which are about 5-10 microns in size.

Whilst I argue that the WHO has had a considerable role in creating mass panic in this case, I also argue that the statistics need to be seen in the light of other, qualitative concerns which make swine flu a red-flag public health concern:

1. Most people, when they think they have flu, actually do not have it. Influenza is painful and debilitating, and only when once one has had real influenza does one realise the difference. Feeling ‘under the weather’ or having man-flu is not the same as having influenza.

2. What makes swine flu a special interest is a list of factors:

a) Normal Asian flu strains manifest differently from European ones. So there is a difference. Swine flu is so to speak a “global” strain.
b) Not that anyone can derive much satisfaction re containment from this “global” nature because viruses mutate and by winter this virus may have another form or forms.
c) From a public health point of view, that people are dying in the summer is worth a red flag. Normally, for instance, several thousand die each year with flu in cold countries in the winters when the conditions for spread are ideal. In other words, the worst is yet to come – in winters.
d) Early trials of swine flu jabs are not coming back very promising.

So while mass panic is unwarranted, one can argue that the awareness is a good thing. For it may well prepare people to deal with the fallout later in the year.

Meanwhile your post may serve to assuage some people in your readership at least so they can deal with the media info flood with discretion.

Forgot to add: from a public health point of view, young children and older adults being ill is not a concern; that people between 20-45 years of age are dying is a considerable concern irrespective of disease. So with swine flu. Thanks.

Shefaly,thanks. Talking about health illiteracy I must narrate something I saw today. A man at the airport had his face wrapped in a handkerchief. And guess what he did? He removed it for a few seconds and put a finger (I am sure it must be quite dirty considering he had been at the airport) up his nose! He picked his nose for a full 10 seconds before he again carefully wrapped the hanky on his face! Another incident at the airport. A man in a surgical mask bought a sandwich and while eating it he shoved the mask on his well oiled hair during the time he ate the sandwich. He did not bother to disinfect or wash his hands before touching the sandwich. One fall-out I was hoping for was awareness about hygiene. But as of yet, I haven’t seen this happening.

Shefaly, there is one more point I wanted to address. In India there is a lot more dirt around and far less hygiene practiced by hotels as compared to hotels and restaurants in the UK and I know you know it. For eg. even a guy in India who uses filtered water for gol gappa/pani puri and uses gloves uses a glove on one hand only, the only with which it dip the puri into the water. With the other hand, he uses his finger nail to tear open the puri! So we in India are exposed to a lot more infections and the chances of us being more resistant is higher. For example a foreigner in India is less likely to be immune to a flu virus, whether it is a stomach flu or seasonal flu, as compared to an Indian and that is why my relatives when they come to India take a flu shot. Also there are some people in India who do not go through a severe influenza illness even though everyone around them has it. My mother in law is one example and so is my mom! Everyone around them is coughing, sneezing and has high fever and nothing happens to them! It is possible that they have been exposed to that in their childhood or perhaps their genetic make-up has changed due to generations of being exposed to a lot of germs. I don’t know what it is, but there are people who seem resistant to some flu viruses or they get a much milder version than others.
years of living abroad reduced the immunity of indians and i know one case of a good friend of mine who used to eat anything on the street and nothing used to happen to her. I am more sensitive to germs! However after a decade of living in the US I am tougher than my friend who now dare not expose herself to anything, and drinks only mineral water when she comes here. We on the other hand drink ordinary water in most hotels.

The role of hands is important in the spread of swine flu to the extent that much is spreading through sneeze droplets. If the men you mention are only keeping their dirty hands to themselves, well, at least they are not infecting others (assuming they were ill). The mask thing is absurd in most cases anyway… Many masks I saw on my last trip were frayed. Talk about trying to freeze water in a sieve.

As for immunity, I have to say, Nita, much depends on one’s individual constitution and general health. My friends, who have lived abroad for shorter periods of time than I, complain of stomach problems (real or made-up, I cannot always judge, but in some cases I am sceptical). But I have never had any stomach problems in India. I eat chaat outside (avoiding chaat walas and sticking instead to places like Bengali Market in Delhi and eating warm tikki etc), I attend weddings so eat much of the stuff served (except salads) and I eat all manner of foods I am deprived of here when I visit my family🙂 Knowing what I know of bottled water, I do not much care for it either. At anyone’s home, I’d drink what they drink and outside, if I am concerned, I stick to drinks which include boiled/ hot water such as tea. I think some of all the stomach problems issue is psychological.

i believe that the high attention given to swine flu is justified due to the folowing reasons.
1. the virus causing this flu is new and people have not developed immunity towards it unlike other seasonal flu viruses
2. there are no vaccines for it yet
3. the virus could mutate and take a more dangerous form

Until a vaccine is developed or the spread of the virus is restricted, the media and the government must put it on the top of their list.

sreekumar
1. this virus is not new. And yes people have immunity towards it and that is why everyone is not getting it. particularly old people. some strains of this flu were there for years. there are some poeple who do not get this flu at all, even though their whole family gets it.
2. in india hardly anyone takes flu vaccines even though they are available abroad and may be in a few select hospitals in india\
3.no, this virus will not mutate and take on a more dangerous form. all news suggests that it will become milder. there is enough information on this. if you google you will find that everything i have mentioned is correct.

nita.
i think having a message from you in the morning should drive the jeebies away.
your analysis and reports about swine flu makes one feel entirely positive.
well..so we don’t have to worry,is it?
good.

vasu, well, we practice hand hygeine and have been doing so for the last 10-15 years. For example I have a hand sanitiser in my purse for all occasions and a few months ago people used to look at me in amusement when I used it, but not today. Today hand santisers have flown off the shelves and I am going to find it difficult to get a replacement!🙂 Also please read the second update I have made on this post. That should answer your doubts and give you ways to avoid infection. All from a certified doctor.

Nita, Your post is very good and well researched. Being a doc reading your blog I feel I should clarify some points raised here.

The virus causing this new pandemic is indeed a new one. The virus is being described as a new subtype of Influenza A (H1N1) not previously detected in swine or humans. The 2009 novel A (H1N1) strain contains an unusual mix of gene segments. It contains genetic materials from four different viruses: from North American swine viruses, North American avian Viruses, human influenza, and two Eurasian swine viruses.
Even though it is a new virus a proportion of old people above the age of 65 seems to have some antibodies against this virus, most probably because of exposure to epidemics of different strains of H1N1 [Not this new virus] that occurred before 1960.
This virus will mutate. There are 2 types of mutations, the antigenic drift and the antigenic shift. Antigenic drift takes place yearly and causes seasonal influenza. It usually produces milder infection but infect a lot of people.
Antigenic shift which produces a new virus takes place about once in 16 years in case influenza virus. This novel H1N1 Influenza A virus is a product of antigenic shift. Antigenic shift usually produces more lethal infection and causes mortality in many healthy individual
charakan, thanks. I appreciate what you wrote but it is too technical for the layman to understand. I think right now we do not know how this virus is going to behave. It is too soon. Sure, the WHO should take all precautions but there is now way to stop the spread of this virus unless all human contact stops. Its best we keep ourselves healthy to fight all diseases. And the way the H1N1 is now, it is very mild, some say milder than seasonal flu. There is no point getting into a panic because it will mutate. It it will, it will and we cannot stop it. We can tackle that problem when it arrives, but right now the swine flu virus is a very mild strain that is going round. That is important to know for the layman. – Nita

in any case nostradamus predicted the end of the world in 2012. he also predicted that prior to the end there would be diseases which would kill 3/4th of all living beings on earth. that all nations would be at proxy war with each other. the end itself will be due to nuclear war.

Nita sorry for making it complicated. Was preparing few slides to show in a local doctor’s meet and I used the same to save time. To a patient or his relative sitting in front of me I will be the reassuring best and say that this is a mild infection in 990 ppl out of 1000. I wont tell them that 10 may need hospitalisation out of which 2 or 3 may die and majority of those who will die will be previously healthy persons. Good thing is as the immunity level in the community increases the disease can become milder

True what you say Charakan, about a tiny minority of healthy people who may die of swine flu too. I am not countering that. All I am saying is that one needs to compare it with other types of influenza and we will find that there is nothing extraordinary about swine flu, at least as of now. Here is a link from which I quote:

THE death of an otherwise healthy person who had swine flu is not unusual…But people do need to remember that with seasonal flu every single year we do have a number of deaths of people who have no risk factors for developing complications. For example, Queensland Health recorded a spike in deaths of healthy people in 2007 from the normal seasonal flu…

You as a doctor know this, but someone reading your comment might become worried. This is not to say that one should not worry about swine flu but only that we should worry about all cases of influeza, whether swine flu or not.
I have a theory about healthy people succumbing to flu by developing complications. From my observation I have noticed that some people are more prone to cough and cold than others and it is possible that either their resistance is low or their lungs are more sensitive. These people may not have any underlying complications and are perfectly healthy individuals without heart disease or diabetes or kidney ailments or whatever. I am sure that they would be more vulnerable to developing complications from from any kind of seasonal flu. Anyway this is just my observation.
And what is worrying is that I hear that there are no vacant hospital beds in and around where I live! People are so terrified that they are getting themselves admitted to hospital. This is sad because there are more serious disease afflicted people who need hospital beds.

Nita: As you cite that link, I think it is worth noting that even in the UK that more people die every winter of seasonal flu than have died so far of swine flu. But as I mentioned in my earlier comment, flu is not a summer disease and we are ok now because schools are closed but that will change shortly. So there is an element of uncertainty here.

For influenza here, jabs are given to vulnerable groups including older people and people with asthma and a propensity for chest infections. Interestingly while ordinary flu is more dangerous for old people, they seem to be lower risk for swine flu. See: http://bit.ly/FW6OJ

Neither in the UK nor in the US, voluntary admission into hospitals is easy (or cheap, in the US). So we are spared this aspect at least.

Nita, Your post helps to allay unreasonable fears propagated by sensationalist media and I really appreciate that.
The Western Countries project large number of deaths related to seasonal flu because even if a terminally ill patient dies of flu like illness they put it as flu death. As you pointed out flu deaths and flu related deaths are different. Actual flu deaths that happen in healthy persons are very less during seasonal flu.
In this novel H1N1 pandemic there are more chances for a healthy person to die than in seasonal flu. This has been proven in several studies currently coming out from USA and Mexico.
You need not panic but should be cautious. Use the simple hygienic tips that you presented in your post and even if you got infected chances of you becoming seriously ill is very very low.
Charakan, There is also no evidence to show that the western nations are calculating swine flu deaths differently from seasonal flu deaths. If you have a link, an authentic one, to prove this, then it will be a good thing. Because the purpose of this post is to show the truth as it is, whether it makes people panic or not. In my post and comments i have reiterated and proved that there is higher death rate in seasonal flu deaths. And please note there are no stats on seasonal flu deaths in India. Thanks. – Nita.

You are asking a very nuanced question re data collection. In one of my comments, to Mr Jatar below, I mention how when reporting deaths here, underlying causes, where applicable, are stressed. So the data IS being collected/ reported in a very granular fashion.

So I have to disagree with Charakan’s assertion “The Western Countries project large number of deaths related to seasonal flu because even if a terminally ill patient dies of flu like illness they put it as flu death.”.

As per a report in DNA of 16 August, the WHO had termed swine flu a level 6 pandemic in May 2009 and warned that it could not be contained, advising governments to focus on treatment instead. But our health ministry slept over it. Nor did it learn from the experiences of the US and UK. It’s only now, after the chaos and neglect, that it has announced a change of strategy. This is a classic goof –up of Ghulam Nabi Azad. He should resign but that will not happen because these kinds of neglect are never an election issue in India. People would soon fight the next crisis, which ever it is!
Indian government should not have wasted precious time and resources on screening and testing instead of focusing on making treatment available immediately to those with the symptoms. Both UK and US learnt this lesson and passed it on to us. But we had to re-learn it. Their current policy is to discourage people from turning up at hospitals, because that’s a great way to spread the virus! India should have immediately set up treatment facilities for high-risk groups like pregnant women, patients with medical complications and children. Dr T John Jacob, former head, department of virology, Christian Medical College, Vellore, says, “We were forewarned way back in May by the WHO that Phase 6 of the pandemic would hit the country. We had the time to formulate a strategic response, but did we do that? What did our system do these three months when we had the advantage of time? Did we in May set up a war room to tackle the flu? Wasn’t that the time for strategic intervention?”
I think the government mixed up public health — where the community is important, not the individual — where you study the disease by tracking it, and individual health, where a single patient is primary. No wonder the crisis got out of hand. For the individual, the approach would be to start treatment and wait for the test results. You stop treatment if he is not affected, and if he is, you continue with it.
As DNA has rightly concluded, “It is terrible to be left without leadership at a time when we are dealing with an issue of such immense visibility.”

Sudhir, I am not sure whether giving tamiflu as a preventive or simply before the test results come is the wisest thing. I am not a medical person but I have read that there are some doubts whether it can be given to pregnant women. There are also people who say that children can react adversely. If this is the case, then only healthy people are left. Whether tamiflu should be given to healthy people who are suspected of having swine flu is open to debate and doctors themselves are divided over it, but if you ask me, if I develop symptoms of cold and cough I would not prefer to take tamiflu. And a fall-out of the strategy where tamiflu is given even before tests are conducted can result in people with minor symptoms demanding it and I am not sure whether this is the best course because of the side-effects of the drug, not to mention the virus becoming resistant to it.
– Nita

Nita, In fact, a majority of the UK’s infected patients have been children and teenagers — a high-risk group. However, most of them are healthy thanks to the thrust on timely treatment. The UK set up pandemic planning departments and a part of the plan was to stock Tamiflu in large quantities. UK now has helplines wherein a patient can list his symptoms and if the medically trained operator feels the case is serious enough, the patient is given another helpline number where he can avail of Tamiflu without any medical prescription. All efforts are simply on the need of the hour – that those with certain symptoms must get Tamiflu immediately. I guess the trained operator would distinguish between those that need the treatment and those that don’t or the vulnerable groups such as pregnant women.

In reporting deaths from swine flu in the UK, there has been an emphatic effort to stress “underlying conditions” without much specificity about what these conditions may have been.

About the swine flu hotline: it is not necessarily staffed by “medically trained operators”, nor is it the result of any strategic thinking on the part of the UK DoH. The hotline only serves England, not the other nations comprising the UK. This is because the health is a devolved function. Most of the operators are 16 year olds who read from a check list and the press is now already reporting undiagnosed cases of meningitis and other more or less dangerous conditions, resulting from this checklist-driven tele-diagnosis. Having seen first hand, how meningitis is often dismissed as “viral fever” even with the patient visiting a hospital in person, I can quite believe such misdiagnoses are possible on the telephone. Also it is inaccurate to say that patients are “given another helpline number”. If the teleoperator determines that the caller has swine flu, the caller gets a reference number which can be used to obtain Tamiflu from a pharmacy in accordance with NHS payment guidelines (we do pay a little something for our prescriptions; in cases where the prescription is for an OTC drug, pharmacies often tell a patient if the non-prescription price of a drug is less than the prescription price; it saves them paperwork and it saves the patient some money). Recently some friends moved to India for a short time. Helping with last minute packing, I was privy to their Tamiflu stockpile.

So I am afraid we have not much clue either. The evidence on Tamiflu is conflicted; the early reports on the jab are mixed and unpromising (given a choice, I will not take it); and there is no clear direction yet on schools reopening which is shortly due or other containment measures when the proverbial heats the radiators in the winter.

Shefaly, I have not studied the issue as you have. So I agree with your your thrust.
My main point is that it is time we realise that there is no point in wasting resources over the inevitable — there is no stopping the H1N1 virus and the sooner the government accepts that, the more capable it will be in dispensing treatment. The strategy should be to administer the Tamiflu and not carry out all kinds of tests and waste time. This should of course be done after proper diagnosis by a medical examination. If it is on telephone, I am also not too sure how effective it is. But I guess, the youngsters would know to advise the patient to consult a doctor, if need be, such as pregnant women and children. The idea is that Tamiflu is not effective if it is delayed. Secondly, long queues for testing as we see in Naidu Hospital or Sassoon Hospital Pune are a great way to spread the virus!

Sudhir: I agree they could advise high-risk groups to see the doctor. But people are lying on the phone to get Tamiflu so it is getting out of hand.

Also a key reason why this is a challenge is this: Normally the NHS rations treatments. That is an open secret. But the unpredictable nature of swine flu means no rationing will be possible so they have to plan to provide for a very high number of ill people and in the process, also save them from dying. As public health management challenges go, this is a hell of a daunting task. And so far, the evidence is that we are reacting, scrambling, not thinking calmly. C’est la vie, I guess.

Over use of Tamiflu may result in production of resistant strains of viruses. We have only very few anti-viral agents to fight with. That is why so much caution in using Tamiflu.

Most patients recover without Tamiflu, even some of the seriously ill patients. In a study of 18 seriously ill patients in Mexico 11 recovered while 7 died. Out of the 11 who recovered 4 did not receive Tamiflu while all those who died received it.
Only the seriously ill need to take it. The problem is how fast one can decide someone is going to have a serious illness.

Charakan: Resistant strains developing is a medium-term issue. In the immediate, Tamiflu is already showing severe undesirable reactions in young children and some adults, with or without underlying conditions already. I don’t think I have said anywhere in my various comments that Tamiflu is some kind of panacea, in fact, au contraire. Thanks.

I was waiting for your post on this!
There is so much contradictory info and media hype I don’t know what to believe😛
There is no panic at all in Chennai and Pondicherry, people are totally calm compared to the absolute swine flu panic I hear about in Pune…
A funny thing a friend told me was that on the first, second and third day you laugh at all the people wearing masks but by the fourth and fifth you get freaked too and buy your own. ^_^

The mean age of death in seasonal flu [in USA] is around 75 while that in this pandemic [[World data] is around 35.
Tamiflu is recommended in pregnancy as the pregnant female is in the high-risk group. So now the guidelines say that even without confirmation Tamiflu should be started in pregnant women. The side effects of Tamiflu are more severe in children but are not lethal. If there is moderate to severe illness due to Novel H1N1, Tamiflu should be taken as the benefits far out weigh the risks.

Nita and Shefaly,
Pardon me if this explanation sounds too technical.
The statistic of seasonal flu related death in USA that is widely quoted of abt 36000 per year is only an estimate. Actual number of deaths in USA in an year in which the treating Physician records in the death certificate Influenza or pneumonia as the immediate or underlying cause of death is only between 5000 and 10000 per year. Using a statistical formula the CDC is estimating that in about 36000 deaths influenza may be the triggering factor. The following link is to the landmark paper in JAMA on which CDC estimate is based.http://jama.ama-assn.org/cgi/content/full/289/2/179
Here is the link to the CDC’s explanation for its estimate.http://www.cdc.gov/flu/about/disease/us_flu-related_deaths.htm
Here is a paragraph from the above web page

CDC does not know exactly how many people die from flu each year. There are several reasons for this: First, states are not required to report individual flu cases or deaths of people older than 18 years of age to CDC. Second, influenza is infrequently listed on death certificates of people who die from flu-related complications. Third, many flu-related deaths occur one or two weeks after a person’s initial infection, either because the person may develop a secondary bacterial co-infection (such as a staph infection) [1,8,11] or because influenza can aggravate an existing chronic illness (such as congestive heart failure or chronic obstructive pulmonary disease) [3]. Also, most people who die from flu-related complications are not tested for flu, or they seek medical care later in their illness when influenza can no longer be detected from respiratory samples. Influenza tests are only likely to detect influenza if performed within a week after onset of illness. For these reasons, many flu-related deaths may not be recorded on death certificates.

As per CDC 90% of these 36000 deaths occur in those above 65 years. 70% occur in those above 75 years of age.

In case of our current Novel H1N1 pandemic all the deaths that are quoted are those in which the deaths are confirmed to be those with the influenza virus infection. It is not an estimate. In this pandemic about 70 percent of deaths is in the age group of 10 to 65.The mean age of death in seasonal flu [in USA] is around 75 while that in this pandemic [[World data] is around 35.
Tamiflu is recommended in pregnancy as the pregnant female is in the high-risk group. So now the guidelines say that even without confirmation Tamiflu should be started in pregnant women. The side effects of Tamiflu are more severe in children but are not lethal. If there is moderate to severe illness due to Novel H1N1, Tamiflu should be taken as the benefits far out weigh the risks. However I disagree with you that swine flu deaths are being more accurately

Charakan, thanks for taking the trouble for the information. I do not doubt that flu deaths are an estimate. That was what I thought too, while I was researching and even mentioned the confusion some people have while recording the deaths. However there is no proof that “In case of our current Novel H1N1 pandemic all the deaths that are quoted are those in which the deaths are confirmed to be those with the influenza virus infection”. However I am open to being convinced otherwise, if you can prove it by giving a link. Wherever I have read a comparison of swine flu and influenza, I have read that the former is less deadly, the way it is now. You may have a gut feel that it is different, but there is no evidence of it so far.
In fact, because swine flu is apparently more contagious, it is believed that far more people have got swine flu and have got cured without testing and medication, thus making the statistics far more deadly than they actually are. About more of the younger lot being infected, I think you yourself have explained very well why this can be so in an earlier comment. Somehow I do not think that this is a reason to be afraid, as it seems logical that older people have been exposed to some form of the virus earlier. – Nita

Data collection in the US and in the UK are completely different processes – mainly driven by the fact that the UK has the NHS which is a centralised database of health records and data is extracted more easily. Your entire argument here is based on the American way of collecting, extrapolating and reporting data so my original disagreement to your assertion “The Western Countries project large number of deaths related to seasonal flu because even if a terminally ill patient dies of flu like illness they put it as flu death.” still stands.

Also because “western countries” also include western European countries which all have nationalised health and do collect data centrally. The USA is not the only “western country”.

Shefaly, Thank you for agreeing that the US flu statistics are over estimates . When a hospitalised patient die the death is registered as per the International code of diseases rules everywhere especially in the Western World including USA and UK .There will be an immediate cause of death and underlying causes. This real true statistic do not show so much flu deaths. Flu related deaths estimation is done in Western Europe similar to USA using certain statistical formulas.

Nita good that you insist on sound evidence . The flu related deaths are estimated after a study of atleast 5 to 10 years of influenza activity pattern in non pandemic years . In case of pandemics with a new virus such estimate can only be derived after the pandemic has been studied for some time . The number of deaths due to Novel H1N1 that you see in the WHO and CDC websites are lab proven diagnosis as mentioned there . But the case fatality rate mentioned for the pandemic is only an estimate.

this blog seems to be abandoned after the debacle regarding some ‘wide eyed india’ or something and we are on to depressing subjects like swine flu(am trying hard to forget it!). is nita on an extended vacation?
Vasudev, my extended vacation will be next month. This time I took just a week off, which is two posts. I returned from my long week-end only on tuesday. Left Mumbai on the previous thursday. Usually I prepare for the week ahead the previous week itself, and now I am preparing for next week. In any case I am not doing any hard stuff because as I mentioned, I will be taking at least 3 weeks off starting from end september as I will be traveling abroad.- Nita

thanks for the information….i am a student of Pune and now at hyd for the holidays declared by the govt of Maharashtra. Today i am leaving to Pune again…thanks a ton for the info yaar….i think i am at the right place at the right time..!!!

i think this post of your needs a publication in all the national newspapers so that the normal man gets to know abt the Flu and the simple precautions needed to be taken and not juss running behind the masks..!!!

The strange mix of ignorance and knowledge is really lethal, and people like the domestic help definitely have ‘a little knowledge is a dangerous thing’ happening. Today in the bazaar I too saw some strange sights like a man removing his mask, clearing his throat and spitting right there. some things will probably never change. But atleast the right info can help…

1) It’s more contagious and easily caught because it’s a newer form of flu and our bodies have not had the opportunity to build up a level of resistance to it that it has from other forms of flu.

2) It’s still just a flu and more people are dying because it’s easier to catch. However, they are not seeking the proper care, nor are they caring for themselves properly. IE: Hydration and rest.

3) Take care of yourself, if you get ill, Hydrate and see your doctor.

But like I said in my last comment (from your most recent post), it’s the negativity that the media is reporting that causes most of the problems. I think we need to use our common sense and do what we always do when ill. Rest, Hydrate, see our doctor. 🙂

Vaccines are POISON. The only one[s] who benefit from vaccines are PHARMACEUTICALS. Lots of Vitamin D will protect you from the flu and many other diseases. DON’T be fooled by paid off media hype. STOP the sickening assault on humanity.

What are the plans for developing 2009 H1N1 vaccine?
Vaccines are the most powerful public health tool for control of influenza, and the U.S. government is working closely with manufacturers to take steps in the process to manufacture a 2009 H1N1 vaccine. Working together with scientists in the public and private sector, CDC has isolated the new H1N1 virus and modified the virus so that it can be used to make hundreds of millions of doses of vaccine. Vaccine manufacturers are now using these materials to begin vaccine production. Making vaccine is a multi-step process which takes several months to complete. Candidate vaccines will be tested in clinical trials over the few months.

Its certainly nice to see a post trying to calm people down like this. Im a simple 21 year old guy, Im not in college, have zero experiance in any medical field, I teach martial arts and cook for a living, and still, a few minutes was how long it took me to do a tiny bit of research around various health websites to find that the Swine flu was no more or less worth worrying about then the standard influenza virus. It just goes to show you, dont believe everything the media tells you, do you own research and see the facts for yourself. Great job reporting this Nita.

I currently have swine flu, and found this article extremely interesting and informative. I’ve had seasonal flu several times in the past, and compared to previous episodes this one seems relatively mild. As I have an underlying chronic condition (COPD) I am taking Tamiflu which does seem to have been effective.
The swine flu panic is media hype designed to sell newspapers and generate advertising revenue. It has been presented as a pandemic plague that will sweep the globe and kill millions. Of course it exists, and of course public health organisations have to deal with it sensibly. In fact it is a currently a mild disease and most people don’t require medication: it is probably better to get it now rather than later before it perhaps mutates into something more severe. That prospect is ironically made more likely by all the efforts to control it.
There is obviously a difficult line to tread between sensible precaution and mass public panic but there could even be a convincing case for just letting it run its course without spending millions of pounds on vaccines and other medication and futile attempts to prevent it spreading. A huge swine flu industry has already developed. The resources saved could be put to better use by improving front-line primary care eg more nurses, better hygiene in hospitals etc.
Thank you Nita for your common sense on the subject. We could do with a lot more of it in the UK.

Thanks Graham for taking the time to leave a comment. I am glad this post was of help to you. – Nita.

The home treatment remedies have number of ways to ease the symptom includes taking adequate liquid and rest. Oral aspirin or paracetamol to relieve pain and fever but with medical advise to children is recommended. Generally, most cases need no medical attention but severe cases with existing underlying conditions should seek a physician.

To prevent the spread of this virus, we have to follow the personal hygiene, should cover the nose and mouth while coughing and sneezing, should regularly wash the hands properly with soaps, should increase the resistance, should drink plenty of water and eat nutritious foods. All should avoid crowded places, unnecessary journeys and contact with sick people. The infected people should stay at home until they are free from all symptoms.

Though the pandemic flu vaccine producing capacity is improved globally, this would not be sufficient to meet out the emergency need of the globe if the present virus changes its form as pandemic. (In this context that it may remember that WHO already declared this spread as pandemic) Even if we produce at the current rate, this will take four years to meet out the global demand.

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